Monoamine oxidase inhibitors restrictions

Ephedra (sea grape, ma-huang, yellow horse) ephedra sinica Relieves colds, improves respiratory function, headaches, diuretic effects 3heart rate, psychosis l hedra should only be used after consulting with the physician. Many restrictions apply and the herb can cause serious reactions. Do not use with cardiac glycosides, monoamine oxidase inhibitor halothane, guanethidine, (MAOIs) or oxytocin. Do not use with 3. John s wort or in weight loss formulas. 

Accordingto the FDA-approved prescribing information for the transdermal selegiline patch, patients receiving the 6 mg/24 hour dose are not required to modify their diet. However, patients receiving the 9 or 12 mg/24 hour dose are still required to follow the dietary restrictions similar to the other monoamine oxidase inhibitors (MAOIs). 

Medication Restrictions for Patients Taking Monoamine Oxidase Inhibitors (MAOIs)... 

Monoamine Oxidase inhibitors (MAOis). There are no controlled studies of MAOIs for the treatment of AN. In addition, the dietary restrictions imposed on patients taking this class of antidepressant and their propensity for lowering blood pressure makes their use in AN inadvisable. In the future, the issue of using MAOis may be reopened with the advent of the so-called reversible MAOis such as moclobemide that apparently do not require a tyramine-restricted diet. 

Monoamine Oxidase Inhibitors (MAOIs). The MAOls work in a unique fashion by blocking the activity of an enzyme that degrades each of three key brain transmitters norepinephrine, dopamine, and serotonin. These widespread effects on several brain transmitter systems make the MAOls a potentially very effective class of medications for a variety of disorders. A few small studies have evaluated the usefulness of the MAOls in the treatment of BPD and found them moderately helpful for the impulsivity associated with this illness. Unfortunately, the requirements for strict dietary restrictions due to a risk of hypertensive crisis severely limit the usefulness of MAOls in the treatment of BPD. These restrictions are a particular concern when treating patients who have problems with impulsivity and are therefore likely to have difficulty maintaining the dietary regimen. For this reason, although they may theoretically be helpful, MAOls should only be used to treat BPD after other more easily tolerated medications have been tried and have failed. In the near future, so-called reversible MAOls that appear to avoid the need for diet restrictions may become available. If so, this will allow us to reconsider their use in the treatment of BPD. For more information regarding the use of MAOls, please refer to Chapter 3. 

In spite of the side effects and special dietary restrictions, your medication (a monoamine oxidase inhibitor) is safe and effective when taken as directed... 

TABLE 7-28. Dietary and drug restrictions for monoamine oxidase inhibitors... 

Shulman Kl, Walker SE, MacKenzie S, et al. Dietary restrictions, tyramine, and the use of monoamine oxidase inhibitors. J Clin Psychopharmacol 1989 9 397-402. 

MAOI and SSRI are acronyms for two types of antidepression medication. MAOI stands for monoamine oxidase inhibitor. MAOIs must be prescribed and used with caution because they tend to dangerously interact with other types of drugs.Today, other forms of antidepressants are usually prescribed for depression patients first. If those medicines do not work, MAOIs are sometimes used with caution. People taking MAOIs have to restrict their diets and watch what other drugs and medicines they take in order to prevent interactions. SSRI, an antidepressant that is more commonly used, stands for selective serotonin reuptake inhibitor.They are generally able to be tolerated by more people and can be used for more minor depressive illnesses. 

The monoamine oxidase inhibitors are associated with a number of undesirable side effects including weight gain, postural hypotension, sexual dysfunction, and insomnia. The most serious side effect is the risk of tyramine-re-lated hypertensive crisis, often referred to as the "cheese effect," which can be fatal. To avoid this situation patients taking MAOIs must limit their tyramine intake, and the restrictive diet required to accomplish this leads to low patient compliance. A similar interaction occurs when switching patients from MAOI to SSRI therapy, and a minimum 2-week washout period before commencement of SSRI therapy is essential to allow MAO levels to return to normal. The therapeutic effects of the TCAs derive from their inhibition of serotonin and norepinephrine uptake, al-... 

Walker SE, Shulman KI, Tailor SA, Gardner D (1996) Tyramine content of previously restricted foods in monoamine oxidase inhibitor diets. J Clin Psychopharmacol 16 383-388... 

Unfortunately, this blocking action is nonselective it enables numerous other substances to score as well. So when MAO defenses are blocked, the body is vulnerable to many potentially dangerous chemical reactions. Obviously, the main problem. with the use of any monoamine oxidase inhibitor is that if it is not used wisely, which is to say sha-manically, one could very easily wind up dead. Dietary restrictions are therefore mandatory when ingesting any AAAO-inhibiting substance, a discipline strictly adhered to by all South American shamans using... 

Selective serotonin reuptake inhibitors (SSRIs) are regarded as first-line treatment in social phobia. Fluvoxamine, paroxetine, and sertraline have been shown to be effective in double-blind placebo-controlled studies. - The irreversible monoamine oxidase inhibitor (MAOI) phenelzine shows robust results in terms of efficacy and has demonstrated (at least anecdotally), its efficacy in improving some of the cognitive aspects associated with SAD. However, phenelzine is usually less well tolerated than alternative treatments due to its associated dietary restrictions and adverse side-effect profile, including sedation and postural hypotension. Results with the reversible inhibitor of monoamine oxidase type A (RiMA) mociobemide are inconsistent. 

Tricyciic antidepressants (TCAs) should be used with caution for patients at high risk of suicide. Monoamine oxidase inhibitors (MAOis) should also be avoided, since chaotic bingeing and purging preclude the necessary dietary restrictions accompanying the use of these agents. 

Shuhnan, K. L, Tailor, S. A. N., Walker, S. E., Gardner, D. M. (1997). Tap (draft) beer and monoamine oxidase inhibitor dietary restrictions. Canadian Journal of Psychiatry, 42, 310-312. 

The monoamine oxidase inhibitors (MAOIs) work through augmented activity of dopamine, as monoamine oxidase normally degrades norepinephrine and serotonin. The MAOIs are rarely used clinically due to their adverse effects, notably orthostatic hypotension, peripheral edema, myoclonic jerks, weakness, and insomnia. Hypertensive crisis can result when combined with sympathomimetics, including over-the-counter products such as ephe-drine and pseudoephedrine. Further, MAOIs are known to contribute to the serotonin syndrome and use of meperidine must be avoided in such patients. Patients on MAOI need to restrict tyramine-rich foods, as well [1,2]. 

Competitive inhibitors bind to specific groups in the enzyme active site to form an enzyme-inhibitor complex. The inhibitor and substrate compete for the same site, so that the substrate is prevented from binding. This is usually because the substrate and inhibitor share considerable stmctural similarity. Catalysis is diminished because a lower proportion of molecules have a bound substrate. Inhibition can be relieved by increasing the concentration of substrate. Some simple examples are shown below. Thus, sulfanilamide is an inhibitor of the enzyme that incorporates j9-aminobenzoic acid into folic acid, and has antibacterial properties by restricting folic acid biosynthesis in the bacterium (see Box 11.13). Some phenylethylamine derivatives, e.g. phenelzine, provide useful antidepressant drags by inhibiting the enzyme monoamine oxidase. The cA-isomer maleic acid is a powerful inhibitor of the enzyme that utilizes the trans-isomer fumaric acid in the Krebs cycle. 

Another approach is to develop selective and reversible MAOIs. The goal again is to produce agents with a minimal risk of tyramine reactions and thus markedly diminish the need for the dietary restrictions that have plagued the use of nonselective and irreversible A, B inhibitors. Collaborative clinical trials of the reversible inhibitors of monoamine oxidase A (RIMAs) in Europe have included more than 2,000 patients, many hospitalized for more severe, endogenous depressive episodes (183). In comparison trials with the TCAs, the onset of effect with RIMAs was also more rapid in some cases. 

Monoamine Oxidase (MAO) Inhibitors. The classical irreversible MAO inhibitors are effective in treating panic disorder, with anecdotal observations suggesting that they may be even more effective than imipramine. Clinical experience with reversible inhibitors of MAO A (RIMAs) (see Chapter 6) is also favorable for the treatment of panic disorder. However, the RIMAs may be somewhat less effective than the irreversible MAO inhibitors, but this is not well established. The disadvantages of the MAO inhibitors make them second- or third-line treatments for panic disorder these include orthostatic hypotension, weight gain, sexual dysfunction, and dietary restrictions (low tyramine diet), with the potential for a tyramine-induced hypertensive crisis. The RIMAs appear safer, with lessened potential for side effects, as discussed in Chapter 6, but also possibly with less efficacy. 

Monoamine oxidase (MAO) is a mitochondrial enzyme found in neural and other tissues, such as the gut and liver. In the neuron, MAO functions as a safety valve to oxidatively deaminate and inactivate any excess neurotransmitter molecules (norepinephrine, dopamine, and serotonin) that may leak out of synaptic vesicles when the neuron is at rest. The MAO inhibitors may irreversibly or reversibly inactivate the enzyme, permitting neurotransmitter molecules to escape degradation and therefore to both accumulate within the presynaptic neuron and to leak into the synaptic space. This causes activation of norepinephrine and serotonin receptors, and may be responsible for the antidepressant action of these drugs. Three MAO inhibitors are currently available for treatment of depression phenelzine [FEN el zeen], isocarboxazid [eye soe kar BOX a zid], and tranylcypromine [tran ill SIP roe meen] no one drug is a prototype. Use of MAO inhibitors is now limited because of the complicated dietary restrictions required of patients taking MAO inhibitors. 

There are several reagents whose uses may be more restricted than those of inhibitors mentioned above but that nevertheless deserve discussion. Flavin-linked monoamine oxidase has been a fruitful enzyme for the development of new inhibitors. Besides being inhibited by acetylenic amines and olefinic amines, the enzyme is also inactivated by hydra-zides and cyclopropyl amines, e.g., the antidepressant drug tranylcypromine. Both of the latter reagents are first turned over by the enzyme before inhibition ensues, but the mechanisms of inhibition remain obscure. Recently, iV-nitroso compounds have been introduced as irreversible inhibitors of proteolytic enzymes. ... 

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